Auditoria interna enquanto ferramenta de apoio à efetividade de políticas públicas de saúde no Brasil: estudo de caso sobre a Política Nacional de Atenção à Saúde dos Povos Indígenas (PNASPI) e o território Yanomami (2020 a 2022)

Abstract

Health is a constitutional right, offered to everyone through public health policies, which include the National Policy for Health Care for Indigenous Peoples (PNASPI), which aims to guarantee access to health actions and services for the indigenous population, according to the principles of the Unified Health System (SUS), considering the different specificities of this population. However, this policy has not yet managed to achieve its effectiveness, given the precarious living conditions of the indigenous population and the choices of political action. In this way, the internal audit presents itself as a Public Administration tool, with the objective of supporting the decisions of government officials and public managers with a view to supporting the effectiveness of the PNASPI in order to promote improvements in the provision of services provided to the indigenous population. In this context, this study is guided by the following research question: how non-conformities highlighted by the internal audit of the Ministry of Health can help in the effectiveness of the National Policy for Health Care for Indigenous Peoples (PNASPI), especially for the Yanomami people and territory? This question is answered in the general objective that sought to identify how nonconformities highlighted by the internal audit can contribute to the effectiveness of the National Policy for Health Care for Indigenous Peoples (PNASPI), especially for the Yanomami people and territory. The specific objectives correspond to: explaining the role of internal audit in the SUS; report on the context of the National Health Care Policy for Indigenous Peoples and the Yanomami Territory; present suggestions for improvements in the audit process to support internal audit instruments. For this purpose, the methodology with a case study design was used; the qualitative approach; the applied nature; exploratory and descriptive objectives and bibliographic and documentary sources were adopted. To this end, internal audit reports carried out at SESAI and DSEI Yanomami, in the municipality of Boa Vista-RR, were analyzed. The main results were: the identification of 7 groups of findings that highlighted 35 noncompliant findings and 73 recommendations. The finding group referring to financial resources presented the highest percentage of nonconformities (45%). From these findings, it was possible to identify the influences that undermine the effectiveness of the PNASPI, as well as the contributions to assist in the effectiveness of this health policy. Among the influences are: increased expenses, with expenses not foreseen in the contracted object; lack of adequate professionals to provide health care; inconsistency in epidemiological data and indicators; waste of medicines, due to expiration dates, etc. Contributions cover: improvement of control, evaluation and monitoring mechanisms of organizational processes and health actions; improvement in the performance of health services provided to the population; reduction of costs of operations and contracts; provision of accurate information to support the planning of health actions, etc. Furthermore, 14 suggestions for improvements were made for the internal audit activity.